Skip to main content

Saturn Medic

Clinical Cases

Pancreatic Cancer

Clinical Subject Page

← Back to Clinical Cases

Also called

Pancreatic carcinoma

ICD-10

C25.9

Specialty

Gastroenterology

Onset

Chronic

Reviewed

July 2026
On This Page

Overview

  • Usually affects adults 60–80 years of age.
  • Common risk factors include smoking, obesity, heavy alcohol consumption, and chronic pancreatitis.
  • Most tumors develop in the head of the pancreas.

Etiology & Risk Factors

-Etiology and Risk factors for Pancreatic Cancer​

  • The exact cause of pancreatic carcinoma is unknown. It develops due to genetic changes that cause uncontrolled growth of pancreatic cells.
  • Risk Factors
  • Smoking (strongest risk factor)
  • Age > 50 years
  • Chronic pancreatitis (especially long-standing)
  • Obesity
  • Type 2 diabetes mellitus
  • High alcohol consumption
  • Occupational exposure to chemicals (e.g., dry cleaning and metalworking industries)
  • Inherited genetic syndromes/family history (about 10% of cases), including BRCA mutations, Peutz-Jeghers syndrome, hereditary pancreatitis, and familial pancreatic cancer

Pathophysiology

Risk factors/genetic mutations → Uncontrolled growth of pancreatic ductal epithelial cells → Ductal adenocarcinoma develops → Tumor enlarges (usually in the head of the pancreas) → Bile duct and pancreatic duct obstruction → Painless jaundice ± pancreatitis → Local invasion of nearby tissues → Spread (metastasis), commonly to the liver → Weight loss, pain, advanced disease.

Clinical Presentation

Early stage of Pancreatic Cancer

  • Usually no symptoms

Constitutional symptoms

  • Weight loss
  • Poor appetite
  • Weakness

Gastrointestinal symptoms

  • Epigastric pain radiating to the back
  • Nausea
  • Painless jaundice (especially with tumors in the head of the pancreas)
  • Pale stools
  • Dark urine
  • Itching (pruritus)
  • Diarrhea/steatorrhea (fatty stools) due to malabsorption

Other features of Pancreatic Cancer

  • Hypercoagulability (e.g., Trousseau syndrome with migratory thrombophlebitis)
Pancreatic Cancer Overview
Pancreatic Cancer Overview

History Taking

Ask about:

  • When did your symptoms start?
  • Do you have upper abdominal (epigastric) pain? Does it radiate to your back?
  • Have you noticed yellowing of your eyes or skin (jaundice)?
  • Is your urine dark or your stool pale?
  • Do you have itching (pruritus)?
  • Have you had unintentional weight loss?
  • Have you lost your appetite?
  • Do you have nausea or vomiting?
  • Have you noticed fatty stools (steatorrhea) or diarrhea?
  • Have you recently developed diabetes or worsening blood sugar control?
  • Do you smoke or have you smoked in the past?
  • How much alcohol do you drink?
  • Have you ever had chronic pancreatitis?
  • Do you have a family history of pancreatic cancer or inherited cancer syndromes (e.g., BRCA mutation)?
  • Have you had any previous pancreatic or biliary disease?

Physical Examination

General Examination of Pancreatic Cancer

  • Weight loss and cachexia
  • Weakness and fatigue
  • Jaundice (yellow skin and sclera)
  • Scratch marks due to itching (pruritus)

Vital Signs

  • Usually normal in early disease
  • Fever may be present if cholangitis or infection develops

Abdominal Examination

  • Epigastric or right upper quadrant tenderness
  • Palpable nontender enlarged gallbladder (Courvoisier sign) with painless obstructive jaundice
  • Palpable abdominal mass (occasionally)
  • Hepatomegaly if liver metastases are present
  • Ascites in advanced disease

Extremities

  • Signs of deep vein thrombosis (DVT)
  • Migratory superficial thrombophlebitis (Trousseau syndrome)

Investigations

1. Laboratory Tests

  • CBC – anemia
  • Liver function tests (LFTs) – ↑ bilirubin, ALP, GGT (obstructive jaundice)
  • Amylase and lipase
  • Blood glucose – may be elevated
  • CA 19-9 – tumor marker (used for prognosis and monitoring, not for screening or diagnosis)
  • CEA – less specific, may be used as an adjunct

2. Imaging

  • Abdominal ultrasound – first test, especially if jaundice is present
  • Contrast-enhanced CT abdomen (pancreas protocol) – investigation of choice for detecting the tumor, assessing spread, and determining resectability
  • MRI/MRCP – if CT is contraindicated or for better evaluation of bile and pancreatic ducts

3. Confirmatory Tests

  • Endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) – gold standard for tissue diagnosis
  • Biopsy – confirms pancreatic carcinoma

4. Additional Tests

  • ERCP – if biliary obstruction is present; allows stent placement and tissue sampling
  • CT chest (or CXR) – to assess for metastasis (staging)

Diagnosis

-Diagnosis of Pancreatic Cancer is based on :

  • Clinical suspicion: Painless jaundice, weight loss, epigastric pain radiating to the back
  • Abdominal ultrasound: Initial test, especially in patients with jaundice
  • Contrast-enhanced CT abdomen (pancreas protocol): Best imaging test to detect the tumor, assess local invasion, metastasis, and resectability
  • MRI/MRCP: Alternative if CT is contraindicated or for further evaluation of the pancreatic and biliary ducts
  • Endoscopic ultrasound (EUS) with fine-needle aspiration (FNA): Confirms the diagnosis by obtaining tissue for histopathology
  • Tumor markers: CA 19-9 (and sometimes CEA) are used for prognosis and monitoring, not for diagnosis or screening
  • CT chest (or CXR): Used for staging to assess distant metastasis
Home / Home / Clinical Cases / Gastrointestinal System Clinical Cases / Pancreatic Cancer

Related Topics

Management

1. Resectable Pancreatic Cancer (Curative)

  • Surgical resection (only curative treatment)
    • Whipple procedure for tumors in the head of the pancreas
    • Distal pancreatectomy ± splenectomy for body/tail tumors
  • Adjuvant chemotherapy after surgery
  • Neoadjuvant therapy may be used for borderline resectable tumors before surgery

2. Unresectable or Metastatic Pancreatic Carcinoma (Palliative)

  • Combination chemotherapy (e.g., FOLFIRINOX or gemcitabine-based regimens)
  • Radiotherapy in selected patients

3. Supportive (Palliative) Care

  • Pain control (WHO analgesic ladder; consider celiac plexus block if severe pain)
  • Nutritional support and pancreatic enzyme replacement if needed
  • Treat biliary obstruction with ERCP and biliary stent (preferred)
  • Manage complications and provide palliative care

Complications

  • Metastasis (most commonly to the liver, lymph nodes, lungs, and adjacent organs)
  • Obstructive jaundice due to bile duct obstruction
  • Cholangitis (infection of the bile ducts)
  • Duodenal/gastric outlet obstruction
  • Ascites (malignant ascites)
  • Venous thromboembolism (VTE), including DVT and pulmonary embolism
  • Migratory thrombophlebitis (Trousseau syndrome)
  • Disseminated intravascular coagulation (DIC)
  • Secondary diabetes mellitus
  • Malnutrition and weight loss (cachexia)
  • The most common cause of death in pancreatic carcinoma is metastatic disease, especially liver metastasis.

Prognosis

  • Pancreatic Cancer has a Very poor prognosis because it is usually diagnosed at an advanced stage.
  • Highly aggressive cancer with early local invasion and metastasis.
  • Overall 5-year survival rate: ~12.8% (depends mainly on disease stage).
  • Metastatic pancreatic cancer: ~3% 5-year survival.
  • Patients who undergo successful surgical resection have a median survival of ~18 months and a 5-year survival of ~20%.

Key Points / Clinical Pearls

  • 95% of Pancreatic Cancer are ductal adenocarcinomas.
  • Most tumors occur in the head of the pancreas (65%).
  • Smoking is the most important risk factor.
  • Classic triad: Painless jaundice + weight loss + epigastric pain radiating to the back.
  • CT pancreas protocol is the imaging test of choice.
  • EUS-guided FNA provides the definitive diagnosis.
  • CA 19-9 is used for monitoring, not for screening.
  • Whipple procedure is the only potentially curative treatment for resectable head tumors.
  • Liver is the most common site of metastasis.
  • Prognosis is poor because most patients present with advanced disease.
  • National Center for Biotechnology Information (NIH). Pancreatic Pseudocyst, StatPearls.
  • Banks PA, Bollen TL, Dervenis C, et al; Acute Pancreatitis Classification Working Group. Classification of Acute Pancreatitis - 2012: Revision of the Atlanta Classification and Definitions by International Consensus. Gut. 2013;62:102-111.
  • Pancreatic Pseudocyst: The Past, the Present, and the Future. World J Gastroenterol. PMC11287700.
  • Systematic Review Comparing Endoscopic, Percutaneous and Surgical Pancreatic Pseudocyst Drainage. World J Gastroenterol. PMC4804189.
  • MedlinePlus, National Library of Medicine (NIH). Pancreatic Pseudocyst: Medical Encyclopedia.
Test yourself

Practice Pancreatic Cancer questions

Lock in what you just read with exam-style MCQs and active-recall flashcards from Saturn Medic.

Q BankGallbladder & Pancreatic Pathology Q BankGastrointestinal Pathology Q BankGastrointestinal Physiology Q BankGastrointestinal Pharmacology Q BankMedicine Q Bank
FlashcardsGastrointestinal Physiology FlashcardsAll Free Flashcards

More in Gastrointestinal System Clinical Cases

SaturnMedic